What health assessment questions should be asked to a patient with diabetes on Semaglutide (Glucagon-like peptide-1 (GLP-1) receptor agonist) or Tirzepatide (Dual Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist)?

Health Assessment Questions for Patients on Semaglutide or Tirzepatide

Patients on semaglutide or tirzepatide require systematic assessment focused on gastrointestinal tolerance, hypoglycemia risk, cardiovascular status, contraindications screening, and treatment response monitoring.

Pre-Treatment and Initial Assessment Questions

Absolute Contraindication Screening

• Do you or any blood relatives have a history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2? This is an absolute contraindication for both medications 1, 2, 3, 4.
• Have you ever had pancreatitis? Use with caution if history is present, though causality has not been definitively established 1, 2, 5.
• Do you have severe gastroparesis or significant gastrointestinal motility disorders? These conditions may worsen with GLP-1 receptor agonist therapy 2.

Baseline Metabolic and Renal Assessment

• What is your current kidney function (eGFR)? No dose adjustment is required across all CKD stages, including eGFR <30 mL/min/1.73 m², but monitor renal function when initiating or escalating doses if severe gastrointestinal reactions occur 1, 3.
• What is your current A1C and fasting glucose? Establish baseline glycemic control to track treatment response 2.
• Do you have any liver problems? No dose adjustment needed for hepatic impairment, but baseline assessment is important 3.

Cardiovascular Risk Stratification

• Do you have established cardiovascular disease (prior heart attack, stroke, or angina)? Semaglutide 2.4mg has proven cardiovascular benefit with 20% reduction in cardiovascular death, nonfatal MI, or nonfatal stroke 2.
• Have you had recent heart failure hospitalization or decompensation? Patients with recent heart failure decompensation should avoid GLP-1 receptor agonists 2.
• What is your current blood pressure and are you on blood pressure medications? Weight loss may necessitate antihypertensive medication adjustment 2.

Medication Reconciliation for Drug Interactions

• Are you currently taking insulin or sulfonylureas (glyburide, glipizide, glimepiride)? These medications increase hypoglycemia risk and require dose reduction when starting GLP-1 receptor agonists 1, 2, 6.
• Are you taking any other GLP-1 receptor agonists or DPP-4 inhibitors? These should be discontinued before starting tirzepatide or semaglutide 2.
• For women: Are you using oral contraceptives? Switch to non-oral contraceptive method or add barrier method for 4 weeks after initiation and each dose escalation with tirzepatide 3.
• Are you taking digoxin? Closer monitoring required if present, especially with hypothyroidism 2.

Ongoing Monitoring Questions (Every Visit)

Gastrointestinal Tolerance Assessment

• Are you experiencing nausea, vomiting, diarrhea, or constipation? These occur in 17-22% (nausea), 13-16% (diarrhea), and 6-10% (vomiting) with tirzepatide, and are typically mild-to-moderate 7, 8, 5.
• How severe are these symptoms and are they improving over time? GI symptoms typically decrease over several weeks to months with dose titration 1, 5.
• Are you able to eat and drink normally? Assess for dehydration risk, especially in elderly patients 2.
• Have you had any persistent severe abdominal pain? This could indicate pancreatitis and requires immediate evaluation 2.

Hypoglycemia Screening

• Have you experienced any episodes of shakiness, sweating, confusion, or blood glucose readings below 70 mg/dL? Hypoglycemia occurs in only 0.2-1.7% of patients not on insulin or sulfonylureas 6, 7.
• Are you skipping meals or eating less due to reduced appetite? Patients must eat moderate amounts of carbohydrates at each meal to prevent hypoglycemia if on insulin or sulfonylureas 2.
• Do you carry glucose tablets or another source of quick-acting carbohydrates? Essential for patients on concomitant insulin or sulfonylureas 2.

Biliary and Hepatic Symptoms

• Have you had any right upper abdominal pain, especially after eating fatty foods? Semaglutide increases gallbladder-related disorders, particularly cholelithiasis, by over 2.6 times 8.
• Have you noticed yellowing of your skin or eyes? Screen for cholecystitis or hepatic complications 2, 8.

Treatment Response Evaluation

• How much weight have you lost since starting treatment? Early responders achieve ≥5% weight loss after 3 months and should continue long-term 2.
• What is your current weight compared to baseline? Tirzepatide achieves 20.9% weight loss at 72 weeks; semaglutide achieves 14.9% 2, 7.
• What is your most recent A1C? Tirzepatide reduces A1C by 1.87-2.24%; semaglutide by approximately 1.4-1.86% 2, 7.

Cardiovascular Monitoring

• Have you had any chest pain, shortness of breath, or palpitations? Monitor for cardiovascular events, though both medications show cardiovascular safety 2, 9.
• Has your blood pressure changed? Weight loss may require antihypertensive adjustment 2.

Medication Adherence and Injection Site Assessment

• Are you taking your medication as prescribed (once weekly on the same day)? Assess adherence patterns 3, 4.
• If you miss doses, how many consecutive doses have you missed? If 2 consecutive doses missed, clinical judgment required; if 3+ doses missed, consider restarting titration schedule 2.
• Are you experiencing any injection site reactions? These are rare (<1%) 1.
• Where are you injecting (abdomen, thigh, or upper arm)? All sites provide similar exposure 3, 4.

Pre-Surgical Assessment Questions

Perioperative Risk Evaluation

• Do you have any upcoming surgeries or procedures requiring anesthesia? Discontinue semaglutide for at least 3 weeks and tirzepatide for 3 weeks before elective surgery due to delayed gastric emptying and aspiration risk 2.
• When was your last dose of medication? Retained gastric contents documented even after extended fasting periods in 24.2% of semaglutide users 2.

Special Population Considerations

For Elderly Patients (≥65 years)

• Are you experiencing any dizziness or dehydration symptoms? Elderly patients require more vigilant monitoring for adverse effects and dehydration from GI side effects 2, 3.

For Patients with Chronic Kidney Disease

• Have you noticed any worsening of kidney function or changes in urination? Monitor renal function when initiating or escalating doses in patients reporting severe GI reactions 1, 3.
• What is your current level of albuminuria? GLP-1 receptor agonists reduce albuminuria and slow eGFR decline 1, 2.

For Women of Childbearing Age

• Are you pregnant, planning to become pregnant, or breastfeeding? Safety in pregnancy not established 3, 4.
• What contraceptive method are you using? Oral contraceptives require switching to non-oral method or adding barrier method with tirzepatide 3.

Treatment Intensification Assessment

Inadequate Response Evaluation (at 12-16 weeks)

• Have you achieved at least 5% weight loss after 3 months? If not, consider discontinuation and alternative approaches 2.
• Is your A1C at goal after 3 months at maximum tolerated dose? If not, consider adding or intensifying other glucose-lowering medications 2.
• Are you following the recommended lifestyle modifications (reduced-calorie diet, 150 minutes/week physical activity, resistance training)? Medications must be combined with lifestyle changes 2.